The Florida Dental Practice Act: The Essentials
The Florida legislature passed the first dentist practice act in 1884. This legislation is known simply as the Florida Dental Practice Act or the Practice Act. Today, it’s Chapter 466 of the Florida Statutes. Like many other practice acts, the Practice Act establishes a licensing board, in this case the Florida Board of Dentistry which consists of eleven members – seven licensed dentists, one dental hygienist, one certified dental technician, and two laypeople who are appointed by the Governor. The Board meets six times a year in its offices in Tallahassee to make crucial decisions on issues relating to all of its licensees.
Also like other practice acts, the Florida Dental Practice Act was designed to protect the general public from unlicensed, incompetent practitioners. But it also serves as the primary source of laws and rules for dental hygienists in Florida. The Practice Act regulates our hygiene licenses, defines the scope of our practice, and sets forth enforcement measures. Pursuant to the Practice Act , Florida licensed dental hygienists have specific statutory requirements to fulfill in order to renew a license. Each year somewhere between two and ten hygiene licenses are permanently revoked. Some licensees lose their licenses because they do not complete the required continuing education. Some lose it because they have been convicted of a misdemeanor or felony. In rarer cases, licensees have their licenses revoked by the Board because their records indicate substance abuse or perhaps some other form of impairment.
The Practice Act and the Rules are constantly being updated with new words or barely changed language that opens potential new violations for licensed dental hygienists. This present FARB-DONE blog is meant to address the most common issues which arise from dental hygienists, their employers and colleagues. We will be writing about the program’s key provisions plus other important rules and regulations so that readers will be able to identify their vulnerabilities under law and be able to recognize the potential for disciplinary action from the Board.
Florida Dental Hygienist Licensing And Requirements
It is important to understand the process of obtaining licensure to practice dental hygiene in Florida. This process begins with an approved educational qualification and completion of required examinations. Florida Statutes require the following qualifications: (1) Have graduated from a school of dental hygiene approved by the board as set forth in Florida Statutes 466.031(1)(b); (2) Have successfully passed a national written examination approved by the board and any clinical or practical exam; and (3) After 1 January 2006, have passed the examination on the laws and rules contained within section 466.
An applicant seeking licensure in the state of Florida must submit the required license examination application and paying the specified fees outlined in Rule 64B5- 2.013, F.A.C. After qualifying approval, the applicant takes the written national board examination. Next, the applicant takes a clinical/practical examination and passes an examination on the laws and rules. Candidates successfully completing the outlined exams are issued a temporary license immediately upon passing the first two exams. As soon as the candidate has successfully completed all exams and has been issued a temporary license, they may begin working as a licensed dental hygienist. The recently passed senate bill 224 allows applicants who are certified to administer local anesthesia for dental hygienists prior to 1 July 2008 to qualify to take the exam for licensure in administering local anesthesia without supervision by a licensed dentist, while applicant holds a temporary dental hygiene license provided legislatively prescribed eligibility requirements are met. Temporary licensed dental hygienists may only function under general supervision of a licensed dentist and may not practice under direct supervision. A Florida limited license to practice dental hygiene allows a licensed dentist in State of Florida to recruit foreign-educated and trained dental workforces and practice dental hygiene in connection with collaborative dental teams. The employment of a dental hygienist by a dentist who is an owner, director, or employee of the dental hygiene program is considered part-time employment. The chair of the dental hygiene program also participates in a dentist-contracted collaborative dental team, must have a curriculum vitae provided on request, and document current evidence of at least 50 hours of continuing education and experience equivalent to that required for licensure as a dental hygienist under Florida Statues section 466. The dental literacy program is a dental hygiene program operated by and in connection with a dentist-contracted model dental practice serving dental clientele in Florida which is located in or is associated with a dental facility in a medically underserved area of Florida. It provides dental services to patients and dental hygiene services to students. The dental hygiene program is regulated by Florida Statue Section 466.856(4).
What Can Dental Hygienists Do in Florida? Practice Act and Rule Overview
As designated by the Florida Administrative Code, hygienists are only authorized to perform dental hygiene duties that are specifically listed. Some of their duties must be performed under the supervision of a dentist, while others can be performed without a supervising dentist present. Because the state of Florida has been recently reviewing the extent of hygienist duties state-wide, the following is a list of the amounts of supervision required for specific procedures per the regulations and what kind of procedures can be performed without a supervising dentist present. These changes were established in early 2013, and some hygienists may still be unaware of these updated regulations.
Duties Requiring Direct Supervision:
• Intraoral/Extraoral duties, which include intraoral monitoring of a patient’s vital signs
• The application of topical anesthetic agents
• The initiation of nitrous oxide and oxygen sedation.
• The performance of clinical functions,
• The delivery of direct patient care
• The performance of controlled acts associated with the practice of dental hygiene, including, but not limited to: 1. The taking of dental radiographs 2. The removal of sutures 3. The placement or removal of an intermediate restoration where there is no pulpal involvement 4. The topical application of fluoride 3. suspension for caries prevention, utilizing fluoride varnish.
Duties Requiring Indirect Supervision:
• The administration of local anesthesia.
• The administration of nitrous oxide and oxygen sedation utilizing a nitrous oxide delivery system, carbon dioxide fresh gas flow apparatus, or other approved nitrous oxide delivery systems
Duties That do Not Require Supervision:
• The administration of local anesthesia.
• The application of a topical medication to a patient’s teeth
• The administration of fluoride via mouthguard or tray delivery system for caries prevention using fluoride solution
Fluoride varnish is just one of many duties that hygienists can perform without the supervising dentist present since the hygienist does not have to place the varnish intra-orally and supervision of the dentist is not needed when administering fluoride treatments, as long as it is on a patient-specific basis and conducted with currently accepted protocols.
Continuing Education And Opportunities
Florida law states that to maintain a valid license, a dental hygienist must complete a total of 30 hours biennially of Board approved continuing education. Five (5) of the 30 CE hours must be related to the subject of medical errors; a maximum of ten (10) hours may be earned with home study courses, courses offered through self-study and on-line courses until July 1, 2022. CE hours in general means those education hours obtained for any purpose during the reporting period of May 31, 2014 – September 30, 2016 and continuing through the current two year cycle ending on February 28, 2019.
Required continuing education hours may be obtained by any of the following means as long as courses are approved by the Board of Dentistry: Attendance at courses given by or under the auspices of any national, state or local professional dental hygiene or other health organization or component dental society; Completion of postdoctoral courses or training given by an accredited dental hygiene school; Home study courses certified by the Board or an entity approved by the Board; Attendance at conventions or meetings of dental hygiene organizations or the Florida Dental Association; Attendance at symposiums or refresher courses which include clinical demonstration or participation; Participation in a preceptorship; Teaching techniques or research activity which are dental hygiene related; or Participation in programs or courses designed to keep abreast of the latest advances in medicine or dentistry .
Taking advanced courses or training in areas such as "pediatric dentistry, treatment of elderly patients, practice management, cardiopulmonary resuscitation, professional liability, discipline and malpractice avoidance, and health care provider law" may be counted as part of the required continuing education hours. Hours obtained for advanced training may not be counted for a period of three years following the date of completion of the training program unless it is proven that the program meets "the requirements for licensure renewal".
It is important to note that while continuing education activities may count toward one licensing requirement, they may not count toward another. For example, if a dental hygienist receives credit for five (5) hours in dental jurisprudence, he or she cannot obtain an additional five (5) hours in this area to count toward the next licensure renewal. Additionally, hours used for renewal of a dental hygiene license cannot be used toward renewal of another type of license (physician, physician assistant, nurse, etc.).
The Board of Dentistry prevails upon dental hygienists that they must often "be offered or designed by a provider or sponsor that is nationally and internationally recognized as an authority in the continuing education of licensed Florida healthcare practitioners who will assure the Board of Dentistry that meeting the standards established above." A dental hygienist group may offer a CE course if a copy of the agenda is sent to the Board of Dentistry Office of Licensure and Testing for review and if the course is open to every licensed Florida dentist and dental hygienist.
The Florida Board of Dentistry’s Role
The Florida Board of Dentistry is the government body responsible for the licensing, registration, and discipline of dentists and dental hygienists in Florida. It is also the agency that’s charged with protecting the public from improper, immoral and unprofessional behavior of dentists, dental hygienists, and dental laboratories practicing their profession in Florida. The Board regulates the practice of dentistry and the practice of dental hygiene. It does so by setting forth specific statutory provisions that must be complied with by dentists and dental hygienists alike. The purpose of these provisions are to ensure that dental professionals achieve and maintain a baseline level of competence and professionalism. They are supposed to help to ensure that the public is not harmed by incompetent and unethical practitioners. Of course, the provisions include penalties for those who fail to adhere to them. Failure to properly care for customers, using defective materials, negligent supervision and training of staff, and other transgressions will all result in penalties and sanctions for the offending practitioners.
Staying Connected: Resources for The Florida Dental Hygienist
For those of you who rely on this blog for information on developments in Florida law regarding dental hygiene, you can rest assured you have access to information that will keep you on top of any legal and professional changes you need to be aware of. In addition to following this blog, there are other ways to stay abreast of developments.
A good first place to look for information is the Florida Association of Dental Hygiene website – www.fadha.net. This site contains a wealth of information about dental hygiene advocacy and a calendar of educational events. You can also stay up to date through the American Dental Hygienists’ Association – www.adha.org. The ADHA typically publishes a professional journal that is an excellent source of information, both academically and legally.
However, if you really want to stay at the forefront of developments, you need to keep yourself informed of updates to the rules and laws governing your practice. As a profession, you are all acutely aware of changes to the dental hygiene laws, such as the passing of legislation permitting hygienists to practice unsupervised in certain facilities , the proposed legislation to allow dental hygiene therapy, and the topic of medical condition disclosures when applying for licensure. These laws and rule changes have a direct impact on your ability to practice and how your office is regulated by state agencies. Board rule changes are discussed in Board meetings which occur quarterly (or more often if a Board emergency meeting occurs). Information relating to these meetings can be found at www.floridasdentistry.gov.
There are also notices of rulemaking activities for the Florida Department of Health on its website, which you can easily subscribe to so that you receive an e-mail communication every time something becomes proposed or just opens up for public comment – www.flrules.org.
A great resource is also the Florida Department of Health website which publishes advisories on a wide variety of topics, from health information systems to new legislative initiatives. It is a great way to catch up on legislative changes that are affecting all Florida residents. www.floridahealth.gov.
These websites can help you stay ahead of the curve and at the forefront of developments that may affect your daily practices.